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LETTER TO EDITOR
Year : 2021  |  Volume : 33  |  Issue : 1  |  Page : 95

Anterior segment optical coherence tomography findings in corneal blood staining


Department of Glaucoma and Cornea, Anand Eye Institute, Hyderabad, Telangana, India

Date of Submission29-May-2020
Date of Decision03-Jul-2020
Date of Acceptance22-Jul-2020
Date of Web Publication26-Mar-2021

Correspondence Address:
Arjun Srirampur
Anand Eye Institute, Habsiguda, Hyderabad - 500 007, Telangana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JOCO.JOCO_219_20

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How to cite this article:
Mansoori T, Srirampur A. Anterior segment optical coherence tomography findings in corneal blood staining. J Curr Ophthalmol 2021;33:95

How to cite this URL:
Mansoori T, Srirampur A. Anterior segment optical coherence tomography findings in corneal blood staining. J Curr Ophthalmol [serial online] 2021 [cited 2021 Apr 18];33:95. Available from: http://www.jcurrophthalmol.org/text.asp?2021/33/1/95/312168

Dear Editor,

Corneal blood staining is a complication that usually occurs after total hyphema of prolonged duration, associated with increased intraocular pressure (IOP).[1] An IOP >25 mmHg for >5 days may result in corneal blood staining. Its reported incidence is 2–11% of traumatic hyphema cases and even higher for total hyphema. Other causes include hyphema induced by intraocular surgery or bleeding in the anterior chamber due to other causes.

In cases of total hyphema, the management should aim to prevent cornea staining, as it can cause vision loss due to corneal opacity, requiring corneal transplantation.[2] Very rarely, corneal blood staining can occur at a low IOP.[3]

Anterior segment optical coherence tomography (AS-OCT) features in corneal blood staining has been described as highly refractive particles in the stroma, infiltrated by red blood cell products.[4]

A 50-year-old patient with visual acuity of light perception underwent transscleral cyclophotocoagulation in the right eye for IOP of 50 mmHg, secondary to neovascular glaucoma, elsewhere. Two weeks later, he presented to us, and the central cornea showed a tan colored, circumscribed, discoid shaped, blood staining, and clear periphery [Figure 1]a. IOP was 04 mmHg. AS-OCT (Optovue, Fremont) showed normal hyperreflective tear film, homogeneous stromal haze, and loss of hyperreflectivity at Descemet's membrane (DM) level [Figure 1]b. In view of poor visual prognosis, no surgical intervention was planned. The patient was lost for follow-up. Patient consent has been obtained.
Figure 1: (a) Slit-lamp photograph of the right eye shows a central, tan colored, discoid shaped corneal blood staining. (b) Anterior segment optical coherence tomography shows homogeneous stromal haze and loss of hyper-reflectivity at the Descemet's membrane level

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We report a rare case of corneal blood staining at low IOP. Clinically, it is important to recognize this entity as it can simulate anterior dislocated lens. It is also relevant to perform serial AS-OCT scans, as any loss of hyperreflectivity at DM level on AS-OCT is an indication of permanent damage to the DM–endothelial complex which can result in permanent corneal blood staining. This sign could be an indication to perform endothelial transplant to replace the damaged DM. Early presentations where the DM is still visualized on AS-OCT can be managed with anterior chamber wash. Hence, serial documentation of AS-OCT could guide the clinician in the management of hyphemas.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
McDonnell PJ, Green WR, Stevens RE, Bargeron CB, Riquelme JL. Blood staining of the cornea. Light microscopic and ultrastructural features. Ophthalmology 1985;92:1668-74.  Back to cited text no. 1
    
2.
Walton W, von Hagen S, Grigorian R, Zarbin M. Management of traumatic hyphema. Surv Ophthalmol 2002;47:297-334.  Back to cited text no. 2
    
3.
Beyer TL, Hirst LW. Corneal blood staining at low pressures. Arch Ophthalmol 1985;103:654-5.  Back to cited text no. 3
    
4.
Ryan DS, Sia RK, Colyer M, Stutzman RD, Wroblewski KJ, Mines MJ, et al. Anterior segment imaging in combat ocular trauma. J Ophthalmol 2013;2013:308259.  Back to cited text no. 4
    


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